Provider Demographics
NPI:1306327267
Name:CROW, MIRANDA CHARLOTTE (DPT)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:CHARLOTTE
Last Name:CROW
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:RENFROE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-8930
Mailing Address - Fax:423-254-5217
Practice Address - Street 1:8904 CROSS PARK DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4703
Practice Address - Country:US
Practice Address - Phone:423-238-7217
Practice Address - Fax:423-238-3473
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist